Clinical significance of electrocardiographic markers of myocardial damage prior to aortic valve replacement

[en] Background: Pre-operative myocardial fibrosis and remodeling impact on outcomes after aortic valve replacement (AVR). We aimed at investigating the prognostic impact of preoperative electrocardiographic (ECG) markers of left ventricular (LV) myocardial damage, i.e. bundle branch block (BBB) and ECG strain pattern after (surgical or transcatheter) AVR for severe aortic stenosis (AS). Methods: Between April 2008 and October 2017, we explored consecutive patients referred to our Heart Valve Clinic for first AVR for severe AS. Detailed pre-operative phenotyping and ECG analysis were performed. Patients were followed-up after AVR for major cardiac events (ME), i.e. cardiovascular death, cardiac hospitalization for acute heart failure and stroke. Results: BBB and ECG strain were respectively observed in 13.5 and 21% of the 1122 patients included. These ECG markers identified a subgroup of older patients, with higher NYHA class and more advanced myocardial disease as detected by echocardiography, i.e. higher LV mass and lower LV ejection fraction, global longitudinal strain and integrated backscatter, than patients without ECG strain or BBB. ME occurred in 212 (18.6%) patients during a mean follow-up of 4.4 ± 1.5 years with higher incidence in case of ECG strain or BBB (HR 1.56, 95%CI 1.13–2.14, p = 0.006; HR 1.47, 95%CI 1.02–2.13, p = 0.04 respectively). The prognostic value of ECG strain remained significant after adjustment for age, diabetes and pre-operative LVEF. Conclusions: Pre-operative ECG markers of myocardial damage identify a subgroup of AS patients at high risk of post-AVR cardiovascular complications irrespective of other prognostic factors and should help the multiparametric staging of cardiac damage to guide AVR. © 2020 Elsevier B.V.

Disciplines :

Cardiovascular & respiratory systems

Author, co-author :

Coisne, A.; CHU Lille, Department of Clinical Physiology and Echocardiography, France, Univ. Lille, U1011 - EGID, Lille, F-59000, France, Inserm, U1011, Lille, F-59000, France, Institut Pasteur de Lille, Lille, F-59000, France

Ninni, S.; Univ. Lille, U1011 - EGID, Lille, F-59000, France, Inserm, U1011, Lille, F-59000, France, Institut Pasteur de Lille, Lille, F-59000, France, CHU Lille, Department of Cardiovascular Medicine, France

Pontana, F.; Univ. Lille, U1011 - EGID, Lille, F-59000, France, Inserm, U1011, Lille, F-59000, France, Institut Pasteur de Lille, Lille, F-59000, France, CHU Lille, Department of Cardiovascular Radiology, France

Aghezzaf, S.; CHU Lille, Department of Clinical Physiology and Echocardiography, France

Janvier, F.; CHU Lille, Department of Clinical Physiology and Echocardiography, France

Mouton, S.; CHU Lille, Department of Clinical Physiology and Echocardiography, France

Ridon, H.; CHU Lille, Department of Clinical Physiology and Echocardiography, France

Ortmans, S.; CHU Lille, Department of Clinical Physiology and Echocardiography, France

Seunes, C.; CHU Lille, Department of Clinical Physiology and Echocardiography, France

Wautier, M.; CHU Lille, Department of Clinical Physiology and Echocardiography, France

More authors (15 more)

Language :

English

Title :

Clinical significance of electrocardiographic markers of myocardial damage prior to aortic valve replacement

Publication date :

2020

Journal title :

International Journal of Cardiology

ISSN :

0167-5273

eISSN :

1874-1754

Publisher :

Elsevier Ireland Ltd

Volume :

307

Pages :

130-135

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 09 July 2020

Statistics

Number of views

94 (5 by ULiège)

Number of downloads

163 (2 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

OpenAlex citations

Bibliography

Baumgartner, H., Falk, V., Bax, J.J., De Bonis, M., Hamm, C., Holm, P.J., et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 38:36 (2017 Sep 21), 2739–2791.
Nishimura, R.A., Otto, C.M., Bonow, R.O., Carabello, B.A., Erwin, J.P., Fleisher, L.A., et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 135:25 (2017 Jun 20), e1159–e1195.
Lamb, H.J., Beyerbacht, H.P., de Roos, A., van der Laarse, A., Vliegen, H.W., Leujes, F., et al. Left ventricular remodeling early after aortic valve replacement: differential effects on diastolic function in aortic valve stenosis and aortic regurgitation. J. Am. Coll. Cardiol. 40:12 (2002 Dec 18), 2182–2188.
Weidemann, F., Herrmann, S., Störk, S., Niemann, M., Frantz, S., Lange, V., et al. Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation. 120:7 (2009 Aug 18), 577–584.
Gilard, M., Eltchaninoff, H., Iung, B., Donzeau-Gouge, P., Chevreul, K., Fajadet, J., et al. Registry of transcatheter aortic-valve implantation in high-risk patients. N. Engl. J. Med. 366:18 (2012 May 3), 1705–1715.
Treibel, T.A., Kozor, R., Schofield, R., Benedetti, G., Fontana, M., Bhuva, A.N., et al. Reverse myocardial remodeling following valve replacement in patients with aortic stenosis. J. Am. Coll. Cardiol. 71:8 (2018 Feb 27), 860–871.
Abdul-Jawad Altisent, O., Puri, R., Regueiro, A., Chamandi, C., Rodriguez-Gabella, T., Del Trigo, M., et al. Predictors and association with clinical outcomes of the changes in exercise capacity after transcatheter aortic valve replacement. Circulation. 136:7 (2017 Aug 15), 632–643.
Orsinelli, D.A., Aurigemma, G.P., Battista, S., Krendel, S., Gaasch, W.H., Left ventricular hypertrophy and mortality after aortic valve replacement for aortic stenosis. A high risk subgroup identified by preoperative relative wall thickness. J. Am. Coll. Cardiol. 22:6 (1993 Nov 15), 1679–1683.
Chin, C.W.L., Messika-Zeitoun, D., Shah, A.S.V., Lefevre, G., Bailleul, S., Yeung, E.N.W., et al. A clinical risk score of myocardial fibrosis predicts adverse outcomes in aortic stenosis. Eur. Heart J. 37:8 (2016 Feb 21), 713–723.
Herrmann, S., Fries, B., Salinger, T., Liu, D., Hu, K., Gensler, D., et al. Myocardial fibrosis predicts 10-year survival in patients undergoing aortic valve replacement. Circ Cardiovasc Imaging., 11(8), 2018 Aug, e007131.
Shah, A.S.V., Chin, C.W.L., Vassiliou, V., Cowell, S.J., Doris, M., Kwok, T.C., et al. Left ventricular hypertrophy with strain and aortic stenosis. Circulation. 130:18 (2014 Oct 28), 1607–1616.
Greve, A.M., Boman, K., Gohlke-Baerwolf, C., Kesäniemi, Y.A., Nienaber, C., Ray, S., et al. Clinical implications of electrocardiographic left ventricular strain and hypertrophy in asymptomatic patients with aortic stenosis: the simvastatin and ezetimibe in aortic stenosis study. Circulation. 125:2 (2012 Jan 17), 346–353.
Guinot, B., Magne, J., Le Guyader, A., Bégot, E., Bourgeois, A., Piccardo, A., et al. Usefulness of electrocardiographic strain to predict survival after surgical aortic valve replacement for aortic stenosis. Am. J. Cardiol. 120:8 (2017 Oct 15), 1359–1365.
Coisne, A., Modine, T., Outteryck, F., Mouton, S., Pilato, R., Ridon, H., et al. Clinical significance of right ventricular longitudinal function parameters after aortic valve replacement. JACC Cardiovasc. Imaging 11:4 (2018 Apr), 651–652.
Coisne, A., Ninni, S., Edmé, J.-L., Modine, T., Mouton, S., Pilato, R., et al. Obesity paradox in the clinical significance of effective prosthetic orifice area after aortic valve replacement. JACC Cardiovasc. Imaging 12:1 (2019 Jan), 208–210.
Lang, R.M., Badano, L.P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 28:1 (2015 Jan), 1–39 (e14).
Di Bello, V., Giorgi, D., Viacava, P., Enrica, T., Nardi, C., Palagi, C., et al. Severe aortic stenosis and myocardial function: diagnostic and prognostic usefulness of ultrasonic integrated backscatter analysis. Circulation. 110:7 (2004 Aug 17), 849–855.
Romhilt, D.W., Estes, E.H., A point-score system for the ECG diagnosis of left ventricular hypertrophy. Am. Heart J. 75:6 (1968 Jun), 752–758.
Hancock, E.W., Deal, B.J., Mirvis, D.M., Okin, P., Kligfield, P., Gettes, L.S., et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J. Am. Coll. Cardiol. 53:11 (2009 Mar 17), 992–1002.
Surawicz, B., Childers, R., Deal, B.J., Gettes, L.S., Bailey, J.J., Gorgels, A., et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J. Am. Coll. Cardiol. 53:11 (2009 Mar 17), 976–981.
Hicks, K.A., Tcheng, J.E., Bozkurt, B., Chaitman, B.R., Cutlip, D.E., Farb, A., et al. 2014 ACC/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (writing committee to develop cardiovascular endpoints data standards). J Am Coll Cardiol. 66:4 (2015 Jul 28), 403–469.
Lancellotti, P., Magne, J., Dulgheru, R., Clavel, M.-A., Donal, E., Vannan, M.A., et al. Outcomes of patients with asymptomatic aortic stenosis followed up in heart valve clinics. JAMA Cardiol. 3:11 (2018 Nov 1), 1060–1068.
Bohbot, Y., Pasquet, A., Rusinaru, D., Delabre, J., Delpierre, Q., Altes, A., et al. Asymptomatic severe aortic stenosis with preserved ejection fraction: early surgery versus conservative management. J. Am. Coll. Cardiol. 72:23 Pt A (2018 Dec 11), 2938–2939.